TX HHS Form H1837. Physician's Statement of Permanent Disability

The Physician’s Statement of Permanent Disability (Form H1837) is a document used by the Texas Health and Human Services Commission (HHSC) to verify whether an applicant for the Supplemental Nutrition Assistance Program (SNAP) meets the state’s definition of a permanent disability. Although the form itself appears brief, its implications are significant: a physician’s confirmation of disability can directly impact a household’s eligibility and documentation requirements for SNAP benefits.

Purpose and Importance of Form H1837

This form allows HHSC to determine whether an applicant experiences a medically verified, long-lasting impairment that substantially limits their ability to work, function, or perform daily activities. The verification helps HHSC apply specific eligibility rules for disabled individuals, such as modified income calculations or exemptions from certain work requirements.

Because disability-related benefits require strict verification, this form serves as an official medical statement and becomes part of the applicant’s case record.

Who Has the Right to Complete or Sign This Form

• A licensed physician must complete and sign the medical section.
• Applicants or household members may not supply their own medical reasoning—only a physician’s professional determination is accepted.
• A caseworker signs the administrative section before the form is given to the physician.

When This Form Is Required, and When It Is Not

• Required when an applicant claims a disability but does not receive SSI, SSDI, VA disability, or other qualifying federal disability proof.
• Required when HHSC needs updated information about a long-standing condition.
• Not required if the applicant already receives verified disability benefits that HHSC recognizes as proof.
• Not required if the impairment is temporary or expected to improve within a short period.

Explanation of Each Section of the Form

Applicant Information Block

This section gathers the applicant’s name, address, case name, and case number. Errors here are common—if the information does not match HHSC records, processing may be delayed.

Caseworker Information

A caseworker signs and dates this portion before the form is provided to the applicant. This signature confirms that the form is officially issued for disability verification.

Physician’s Medical Determination

The physician must check one or more boxes that describe the applicant’s permanent condition. These conditions represent legally recognized categories of permanent disability under Texas guidelines. They include:

• Permanent loss of use of limbs
• Amputations (including diabetes-related or vascular-related amputations)
• Total deafness not correctable with devices
• Statutory blindness unrelated to cataracts or detached retina
• IQ of 59 or below established after age 16
• Spinal cord or nerve root lesions resulting in paraplegia or quadriplegia
• Advanced multiple sclerosis
• Muscular dystrophy with severe impact on limb use
• Chronic renal disease with severe impairment or dialysis/transplant needs
• Amputation with age 55 or older
• Advanced AIDS with recurring physical or mental impairment
• Or a declaration that none of the listed disabling conditions apply

The physician then provides a signature, date, address, and telephone number. Missing contact information is a frequent cause of HHSC delays.

Typical Mistakes Applicants Encounter

• Submitting the form without the caseworker’s initial signature.
• Providing incomplete physician contact information.
• Using a nurse practitioner or physician assistant when the form requires a licensed physician.
• Leaving the form unsigned or undated.
• Failing to return the form to HHSC, not the clinic.

Practical Tips for Completing the Form

• Bring your HHSC case number to the physician to avoid administrative errors.
• Ask your doctor to return the form directly to HHSC whenever possible; this prevents lost paperwork.
• If the condition requires additional medical documentation, attach recent test results or notes.
• Ensure all checkboxes and dates are clearly marked to avoid re-verification.

Real-Life Situations Where This Form Is Needed

• A man with long-term paralysis applies for SNAP but has not yet qualified for federal disability; HHSC requests Form H1837 for verification.
• An older woman with diabetes-related leg amputation needs documentation confirming permanent disability for SNAP work exemptions.
• A patient undergoing dialysis provides this form to demonstrate severe renal impairment when federal disability decisions are still pending.
• A person with advanced multiple sclerosis uses the form because their condition is permanent and significantly restricts daily function.

Documents Commonly Submitted Alongside This Form

• Recent medical records confirming the diagnosis
• Hospital discharge summaries
• Amputation or surgical records
• Neurological or renal function reports
• Hearing or vision test results

FAQ – Common Questions

• Who completes the medical section? Only a licensed physician may complete and sign the medical assessment.
• Is this form mandatory for all SNAP applicants? No, only for applicants who claim disability without existing federal disability verification.
• Where do I send the completed form? Return it to the HHSC office listed in the header—not directly to the state office unless noted.
• Can HHSC share this medical information? Yes, it may be shared with other government agencies or the applicant’s representative as allowed by law.
• Does the form expire? Not officially, but HHSC may require updated verification depending on the case.

Micro-FAQ (Short Answers for Quick Reference)

• Purpose? To verify permanent disability for SNAP eligibility.
• Who files? The applicant, using medical confirmation from a licensed physician.
• Who signs? A caseworker and a physician.
• Deadline? Usually as requested by HHSC; delays may affect eligibility.
• Attachments? Optional medical records supporting the physician’s statement.
• Submitted to? The specific HHSC eligibility office listed on the form.
• Is it required for SSI recipients? No, federal disability verification replaces it.
• What if no conditions apply? The physician marks “NO,” and HHSC evaluates the case accordingly.

Related Forms

• Texas SNAP Work Requirement Exemption Form
• Form H1010 – Application for Benefits
• Form H1836 – Medical Release/Physician’s Statement
• Form H1326 – Disability Determination Notice

Form Details

• Form Name: Physician's Statement of Permanent Disability
• Form Number: H1837
• Region: Texas Health and Human Services Commission (HHSC)
• Edition: March 2019-E